Obesity:  The Bariatric Challenge Chad S Lewis, MD Emergency Medicine Resident Albany Medical Center
Obesity Defined <ul><li>Condition of an excessive proportion of adipose tissue to total body weight </li></ul><ul><li>Prev...
Epidemic Proportions:  US 1991 through 1998  <ul><li>Percentage of obese men doubled  </li></ul><ul><li>Percentage of obes...
Pathophysiology <ul><li>High caloric intake </li></ul><ul><li>Low level of physical activity </li></ul><ul><li>Low level o...
BMI  weight and height <ul><li>25 to 29.9 kg/m 2 : overweight  </li></ul><ul><li>30 to 34.9 kg/m 2 : obese  (class I obesi...
Higher risk <ul><li>Heart disease </li></ul><ul><li>Diabetes  </li></ul><ul><li>Hypertension </li></ul><ul><li>Stroke </li...
Heart Disease <ul><li>Overall increase in both morbidity and mortality </li></ul><ul><ul><li>Coronary artery disease </li>...
Pulmonary Problems <ul><li>Decrease in lung volumes </li></ul><ul><li>Increased work of breathing </li></ul><ul><ul><li>Hi...
Pulmonary Problems <ul><li>Pulmonary hypertension secondary to: </li></ul><ul><ul><li>Hypoxia  </li></ul></ul><ul><ul><li>...
Obesity-hypoventilation syndrome:  Pickwickian syndrome <ul><li>5% -- 10% of morbidly obese  </li></ul><ul><li>Left and ri...
Cancer Mortality <ul><li>Men: </li></ul><ul><ul><li>Stomach  </li></ul></ul><ul><ul><li>Prostate  </li></ul></ul><ul><li>W...
Obstetrics and Gynecology <ul><ul><li>Female infertility  </li></ul></ul><ul><ul><li>Disrupted menstruation and ovulation ...
Obesity and Trauma <ul><li>Premorbid risk factor </li></ul><ul><li>Interference with activities of daily living </li></ul>...
Obesity and Trauma <ul><li>Head injury protection in blunt trauma  </li></ul><ul><li>Higher incidence chest injuries </li>...
Prehospital Challenges <ul><li>Delays due to problems in moving and transport </li></ul><ul><li>Appropriate sized gurneys ...
Airway <ul><li>Difficulties with intubation and BVM </li></ul><ul><li>Preoxygenation is critical </li></ul><ul><ul><li>Des...
Assessment of Airway
Airway Techniques <ul><li>Rolled towels or blankets </li></ul><ul><ul><li>between scapula  </li></ul></ul><ul><ul><ul><li>...
Alternate Airways <ul><li>Awake oral intubation </li></ul><ul><li>Blind nasotracheal intubation </li></ul><ul><li>LMA </li...
Anticipate airway difficulty <ul><li>Awake techniques if possible   </li></ul><ul><li>pre oxygenate in reverse Trendelenbu...
Sphygmomanometry <ul><li>Inadequate width and circumference can artificially elevate blood pressure </li></ul><ul><li>Cuff...
Pulse Oximetry <ul><li>Tissue thickness impedes light wave transmission </li></ul><ul><li>Other areas of placement </li></...
Venous Access <ul><li>Landmark vessels not visualized or palpated </li></ul><ul><li>Multiple attempts </li></ul><ul><li>De...
Improving Chances at  Venous Access <ul><li>Applying heat </li></ul><ul><li>Light tapping over vessels </li></ul><ul><li>A...
ECG Difficulties <ul><li>Difficult landmarks for lead placement </li></ul><ul><li>Decreased or inconsistent voltage </li><...
ECG Differences <ul><li>ECGs of 100 obese subjects and 100 normal subjects no evidence of cardiac disease  </li></ul><ul><...
EMS Challenges <ul><li>transporting people in a manner that is as safe as possible both for the personnel and their patien...
Meeting the Challenge <ul><li>EMS providers must conduct pre-planning exercises to prepare for attending to special situat...
Current Education <ul><li>EMT Paramedic Curriculum minimally covers obese patients  </li></ul><ul><ul><li>teaching that ac...
Provider Challenges <ul><li>Logistics </li></ul><ul><ul><li>Labor intensive </li></ul></ul><ul><ul><li>Equipment unaccommo...
Safety in equipment <ul><li>A standard box-shaped ambulance  </li></ul><ul><ul><li>40- to 44-inch width inside of the pati...
FDNY Guidelines <ul><li>Paramedic unit is called to the scene to determine: </li></ul><ul><ul><li>Patient’s condition </li...
FDNY Guidelines <ul><li>Removal considerations </li></ul><ul><ul><li>How to be packaged </li></ul></ul><ul><ul><ul><li>Sto...
Obstacles in Transport <ul><li>Removing the patient from the scene </li></ul><ul><li>Packaging and transferring </li></ul>...
Challenges of Removal <ul><li>Non-mobile patients </li></ul><ul><li>Patients unable to fit through doorway </li></ul><ul><...
Transferring <ul><li>Standard backboard </li></ul><ul><ul><li>Patient may not fit </li></ul></ul><ul><ul><li>Board unable ...
Transferring <ul><li>Options to the standard backboard </li></ul><ul><ul><li>Specialized backboards </li></ul></ul><ul><ul...
Creating Company Policy <ul><li>Address the concerns </li></ul><ul><li>identifies strategies </li></ul><ul><li>sets limits...
Creating Company Policy <ul><li>Provide routine training that includes new strategies for morbidly obese patients in both ...
Company Policy <ul><li>Obtain proper equipment that is reasonably priced </li></ul><ul><ul><li>Heavy rated stokes baskets ...
Various Response Methods used by EMS agencies <ul><li>Patients that are too heavy for a 2-person medic unit can request fi...
Proflexx with LBS
 
 
 
 
More Questions than Answers <ul><li>Is there a demand for a stretcher that could carry persons in excess of 500 lb? </li><...
Many More Questions than Answers <ul><li>Would a larger ambulance stretcher allow enough room to provide patient care? </l...
Some Helpful Pointers <ul><li>Size-up building, check stairs and other escape routes  </li></ul><ul><li>Think outside the ...
Best Practices <ul><li>Non-emergent transport </li></ul><ul><ul><li>Ascertain patient size </li></ul></ul><ul><ul><li>Sche...
More Helpful Tips <ul><li>Treat patient with dignity </li></ul><ul><li>Establish a system  </li></ul><ul><ul><li>Write pro...
More Helpful Tips <ul><li>Scene assessment </li></ul><ul><ul><li>Door width </li></ul></ul><ul><ul><li>Steps  </li></ul></...
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Obesity: The Bariatric Challenge Obesity: The Bariatric Challenge

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Obesity: The Bariatric Challenge Obesity: The Bariatric Challenge

  1. 1. Obesity: The Bariatric Challenge Chad S Lewis, MD Emergency Medicine Resident Albany Medical Center
  2. 2. Obesity Defined <ul><li>Condition of an excessive proportion of adipose tissue to total body weight </li></ul><ul><li>Prevalence doubled over last 20 years and still increasing </li></ul><ul><li>Some estimates are half of all adults are considered to be overweight </li></ul><ul><li>Worldwide estimates 1.1 billion overweight people with 250 million are classified as obese </li></ul><ul><li>Body mass index (BMI) used as a measurement </li></ul>
  3. 3. Epidemic Proportions: US 1991 through 1998 <ul><li>Percentage of obese men doubled </li></ul><ul><li>Percentage of obese women increased by 50% </li></ul><ul><li>More than 31% of adults in the US are obese </li></ul><ul><li>More than 64% of Americans are overweight </li></ul>
  4. 4. Pathophysiology <ul><li>High caloric intake </li></ul><ul><li>Low level of physical activity </li></ul><ul><li>Low level of metabolism </li></ul><ul><li>High insulin sensitivity? </li></ul><ul><li>Lack of anti-obesity hormone? </li></ul>
  5. 5. BMI weight and height <ul><li>25 to 29.9 kg/m 2 : overweight </li></ul><ul><li>30 to 34.9 kg/m 2 : obese (class I obesity) </li></ul><ul><li>35 to 39.9 kg/m 2 : moderately obese (class II obesity) </li></ul><ul><li>40 to 49.9 kg/m 2 : severely obese (class III obesity) </li></ul><ul><li>>50.0 kg/m 2 : super morbidly obese (class IV obesity) </li></ul>
  6. 6. Higher risk <ul><li>Heart disease </li></ul><ul><li>Diabetes </li></ul><ul><li>Hypertension </li></ul><ul><li>Stroke </li></ul><ul><li>Osteoarthritis </li></ul><ul><li>Kidney disease/stones </li></ul><ul><li>Psychiatric issues </li></ul><ul><ul><li>Impaired body image </li></ul></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Loss of self esteem </li></ul></ul>
  7. 7. Heart Disease <ul><li>Overall increase in both morbidity and mortality </li></ul><ul><ul><li>Coronary artery disease </li></ul></ul><ul><ul><li>Atherosclerosis and hyperlipidemia </li></ul></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>CHF </li></ul></ul><ul><ul><li>Sudden cardiac death </li></ul></ul><ul><ul><li>Peripheral vascular disease </li></ul></ul><ul><li>As weight increases risks get higher </li></ul>
  8. 8. Pulmonary Problems <ul><li>Decrease in lung volumes </li></ul><ul><li>Increased work of breathing </li></ul><ul><ul><li>Higher airway resistance </li></ul></ul><ul><ul><li>Higher chest wall </li></ul></ul><ul><ul><li>Decreased respiratory system compliance </li></ul></ul><ul><ul><li>Flattened diaphragms </li></ul></ul><ul><ul><li>Altered lung volumes </li></ul></ul><ul><ul><li>Increased energy cost of breathing </li></ul></ul>
  9. 9. Pulmonary Problems <ul><li>Pulmonary hypertension secondary to: </li></ul><ul><ul><li>Hypoxia </li></ul></ul><ul><ul><li>Pulmonary vasoconstriction </li></ul></ul><ul><ul><li>Depressed heart function </li></ul></ul>
  10. 10. Obesity-hypoventilation syndrome: Pickwickian syndrome <ul><li>5% -- 10% of morbidly obese </li></ul><ul><li>Left and right sided heart failure common </li></ul><ul><li>Obstructive sleep apnea </li></ul><ul><li>Hypoxia </li></ul><ul><li>Hypercapnia </li></ul><ul><li>Marked daytime somnolence </li></ul><ul><li>Chronic respiratory acidosis </li></ul>
  11. 11. Cancer Mortality <ul><li>Men: </li></ul><ul><ul><li>Stomach </li></ul></ul><ul><ul><li>Prostate </li></ul></ul><ul><li>Women: </li></ul><ul><ul><li>Breast </li></ul></ul><ul><ul><li>Uterus </li></ul></ul><ul><ul><li>Cervix </li></ul></ul><ul><ul><li>Ovary </li></ul></ul>
  12. 12. Obstetrics and Gynecology <ul><ul><li>Female infertility </li></ul></ul><ul><ul><li>Disrupted menstruation and ovulation </li></ul></ul><ul><ul><li>Early menstruation </li></ul></ul><ul><ul><li>Urinary incontinence </li></ul></ul><ul><ul><li>Abnormal labor </li></ul></ul><ul><ul><li>Increased progression to Cesarean section </li></ul></ul><ul><ul><li>Increased fetal size </li></ul></ul><ul><ul><li>Pre-eclampsia and eclampsia </li></ul></ul><ul><ul><li>Gestational diabetes </li></ul></ul>
  13. 13. Obesity and Trauma <ul><li>Premorbid risk factor </li></ul><ul><li>Interference with activities of daily living </li></ul><ul><li>Displaced ankle and elbow fractures with minimal trauma </li></ul><ul><li>Less likely to wear seat belts </li></ul><ul><li>Subcutaneous fat hides physical findings </li></ul>
  14. 14. Obesity and Trauma <ul><li>Head injury protection in blunt trauma </li></ul><ul><li>Higher incidence chest injuries </li></ul><ul><ul><li>Physiologic airbag </li></ul></ul><ul><ul><li>Rib fractures </li></ul></ul><ul><ul><li>Pulmonary contusions </li></ul></ul><ul><ul><li>Higher mortality due to respiratory causes </li></ul></ul><ul><li>Higher incidence of pelvic fractures </li></ul>
  15. 15. Prehospital Challenges <ul><li>Delays due to problems in moving and transport </li></ul><ul><li>Appropriate sized gurneys </li></ul><ul><li>Excessive tissue impeding access for giving fluids, taking BP </li></ul><ul><li>Mobilization of manpower </li></ul><ul><li>Managing airways </li></ul><ul><li>Pulse oximetry </li></ul>
  16. 16. Airway <ul><li>Difficulties with intubation and BVM </li></ul><ul><li>Preoxygenation is critical </li></ul><ul><ul><li>Desaturation is quicker </li></ul></ul><ul><ul><li>Sitting upright or semirecumbent as long as possible </li></ul></ul><ul><ul><li>Reduced pulmonary compliance </li></ul></ul><ul><ul><ul><li>Higher ventilatory pressures </li></ul></ul></ul><ul><ul><ul><li>May need to occlude pop-off valve to ventilate </li></ul></ul></ul>Brazilian Journal of Anesthesiology, 2005; 55: 2: 256-260 Tracheal Intubation of Morbidly Obese Patients: A Useful Device Ricardo Francisco Simoni
  17. 17. Assessment of Airway
  18. 18. Airway Techniques <ul><li>Rolled towels or blankets </li></ul><ul><ul><li>between scapula </li></ul></ul><ul><ul><ul><li>Displaces breast tissue </li></ul></ul></ul><ul><ul><ul><li>Chest wall can obstruct handle </li></ul></ul></ul><ul><ul><li>under the occiput </li></ul></ul><ul><ul><ul><li>Allows for sniffing position </li></ul></ul></ul><ul><ul><ul><li>Creates more space for the handle </li></ul></ul></ul><ul><li>Shorter than average handle </li></ul><ul><li>Adjustable angle laryngoscope </li></ul>Brazilian Journal of Anesthesiology, 2005; 55: 2: 256-260 Tracheal Intubation of Morbidly Obese Patients: A Useful Device Ricardo Francisco Simoni
  19. 19. Alternate Airways <ul><li>Awake oral intubation </li></ul><ul><li>Blind nasotracheal intubation </li></ul><ul><li>LMA </li></ul><ul><li>Esophageal-tracheal double lumen </li></ul><ul><li>Cricothyrotomy </li></ul>
  20. 20. Anticipate airway difficulty <ul><li>Awake techniques if possible   </li></ul><ul><li>pre oxygenate in reverse Trendelenburg position </li></ul><ul><li>for RSI consider increased dose of meds </li></ul><ul><li>LMA has increased risk for aspiration </li></ul><ul><li>Neck anatomy distorted due to excess tissue </li></ul>
  21. 21. Sphygmomanometry <ul><li>Inadequate width and circumference can artificially elevate blood pressure </li></ul><ul><li>Cuff width to arm circumference </li></ul><ul><ul><li>Ratio of 2 : 5 </li></ul></ul><ul><ul><li>Bladder length 80% arm circumference </li></ul></ul><ul><li>Important to have variety of cuffs </li></ul>
  22. 22. Pulse Oximetry <ul><li>Tissue thickness impedes light wave transmission </li></ul><ul><li>Other areas of placement </li></ul><ul><ul><li>Earlobe </li></ul></ul><ul><ul><li>Fifth digit of hand or foot </li></ul></ul><ul><ul><li>Nose </li></ul></ul><ul><ul><li>Lip </li></ul></ul><ul><ul><li>Temporal artery </li></ul></ul>
  23. 23. Venous Access <ul><li>Landmark vessels not visualized or palpated </li></ul><ul><li>Multiple attempts </li></ul><ul><li>Delay in access </li></ul><ul><li>Higher complication rates </li></ul><ul><ul><li>Secondary to multiple sticks </li></ul></ul><ul><ul><li>Wound infections </li></ul></ul><ul><ul><li>Phlebitis </li></ul></ul><ul><ul><li>Thrombosis </li></ul></ul><ul><li>Standard 1.5-in needles not long enough </li></ul><ul><li>3-4-in needles and catheters preferred </li></ul>
  24. 24. Improving Chances at Venous Access <ul><li>Applying heat </li></ul><ul><li>Light tapping over vessels </li></ul><ul><li>Active or passive pumping of extremity </li></ul><ul><li>Topical nitroglycerin* </li></ul><ul><li>Intraosseous </li></ul><ul><li>Reactive Hyperemia </li></ul><ul><ul><li>Occlude with BP cuff 3-4 minutes </li></ul></ul><ul><ul><li>Release 10-15 mmHg below diastolic </li></ul></ul>
  25. 25. ECG Difficulties <ul><li>Difficult landmarks for lead placement </li></ul><ul><li>Decreased or inconsistent voltage </li></ul><ul><li>Increased fat deposits around the heart </li></ul><ul><li>Flat/inverted T waves inferior leads </li></ul><ul><ul><li>Consistent change in obesity </li></ul></ul><ul><ul><li>Non-specific </li></ul></ul>
  26. 26. ECG Differences <ul><li>ECGs of 100 obese subjects and 100 normal subjects no evidence of cardiac disease </li></ul><ul><li>P, QRS, and T wave axes were more leftward </li></ul><ul><li>More LVH </li></ul><ul><li>left atrial abnormality and </li></ul><ul><li>T wave flattening in the inferior and lateral leads </li></ul><ul><li>Prolonged QT interval </li></ul><ul><li>Alpert et al American Journal Cardiology 2000 </li></ul>
  27. 27. EMS Challenges <ul><li>transporting people in a manner that is as safe as possible both for the personnel and their patients, as well as in a respectful manner </li></ul><ul><li>2000-2001 injuries related to transferring and handling of patients represented at least 50% of Workers’ Compensation annual costs. </li></ul><ul><li>2 or 3 people are available to move a patient from one spot to another </li></ul><ul><li>Just one injury could mean the end to an EMT or paramedic’s career </li></ul><ul><li>transporting people in a manner that is as safe as possible both for the personnel and their patients, as well as in a respectful manner </li></ul><ul><li>Transporting the Morbidly Obese Patient: Framing an EMS Challenge Journal of Emergency Nursing August 2002 </li></ul>
  28. 28. Meeting the Challenge <ul><li>EMS providers must conduct pre-planning exercises to prepare for attending to special situations. </li></ul><ul><li>Experts advocate for the following: </li></ul><ul><ul><li>creation of policy and procedures </li></ul></ul><ul><ul><li>pre-training </li></ul></ul><ul><ul><li>continuing education </li></ul></ul><ul><ul><li>request for lift assistance </li></ul></ul><ul><ul><li>community involvement </li></ul></ul><ul><ul><li>use of equipment that helps patients without harming workers. </li></ul></ul><ul><li>Even with the best intentions, treating and transporting morbidly obese patients will take more time than almost any other type of call to which EMS responds </li></ul><ul><li>Transporting the Morbidly Obese Patient: Framing an EMS Challenge </li></ul><ul><li>Journal of Emergency Nursing August 2002 </li></ul>
  29. 29. Current Education <ul><li>EMT Paramedic Curriculum minimally covers obese patients </li></ul><ul><ul><li>teaching that accommodations may be necessary </li></ul></ul><ul><ul><li>Need to use appropriately sized diagnostic devices </li></ul></ul><ul><ul><li>Maintain professionalism </li></ul></ul><ul><ul><li>Notes that the paramedic may require additional assistance </li></ul></ul>
  30. 30. Provider Challenges <ul><li>Logistics </li></ul><ul><ul><li>Labor intensive </li></ul></ul><ul><ul><li>Equipment unaccommodating </li></ul></ul><ul><ul><ul><li>Securing antler must be dismantled </li></ul></ul></ul><ul><ul><ul><li>Transport from ambulance floor </li></ul></ul></ul><ul><ul><li>Unsafe transports </li></ul></ul><ul><ul><li>Undignified transports </li></ul></ul><ul><li>Medication requirements </li></ul><ul><li>Bias </li></ul>
  31. 31. Safety in equipment <ul><li>A standard box-shaped ambulance </li></ul><ul><ul><li>40- to 44-inch width inside of the patient compartment </li></ul></ul><ul><ul><li>crash tested and rated for a payload max 1600 pounds </li></ul></ul><ul><li>Patient weighing 700 pounds </li></ul><ul><ul><li>can measure 50 to 55 inches wide </li></ul></ul><ul><ul><li>2 or 3 health care providers needed to care for the patient could together weigh 600 pounds </li></ul></ul><ul><ul><li>Little room is left for the equipment and supplies required. </li></ul></ul>
  32. 32. FDNY Guidelines <ul><li>Paramedic unit is called to the scene to determine: </li></ul><ul><ul><li>Patient’s condition </li></ul></ul><ul><ul><li>If removal is emergent/life threatening or non-emergent </li></ul></ul><ul><ul><li>If patient can be treated at the scene or must be moved to the hospital </li></ul></ul>
  33. 33. FDNY Guidelines <ul><li>Removal considerations </li></ul><ul><ul><li>How to be packaged </li></ul></ul><ul><ul><ul><li>Stokes stretcher </li></ul></ul></ul><ul><ul><ul><li>Body bag </li></ul></ul></ul><ul><ul><li>Method </li></ul></ul><ul><ul><ul><li>Carry drag </li></ul></ul></ul><ul><ul><ul><li>Lower </li></ul></ul></ul><ul><ul><ul><li>Ropes or slings </li></ul></ul></ul><ul><ul><li>Removal route to ambulance </li></ul></ul><ul><ul><li>Need for additional resources </li></ul></ul><ul><ul><ul><li>Collapse unit </li></ul></ul></ul><ul><ul><ul><li>Forklift </li></ul></ul></ul><ul><ul><ul><li>Flatbed truck </li></ul></ul></ul>
  34. 34. Obstacles in Transport <ul><li>Removing the patient from the scene </li></ul><ul><li>Packaging and transferring </li></ul><ul><li>Moving to the ambulance </li></ul><ul><li>Transportation </li></ul><ul><li>Preplanning </li></ul>
  35. 35. Challenges of Removal <ul><li>Non-mobile patients </li></ul><ul><li>Patients unable to fit through doorway </li></ul><ul><li>Solution can be in removal of walls or windows </li></ul><ul><ul><li>Requires heavy rescue equipment </li></ul></ul><ul><ul><li>Rescuers with engineering/construction experience </li></ul></ul><ul><ul><li>Can lead to building collapse </li></ul></ul><ul><ul><li>Risk of injury to patient and crew </li></ul></ul>
  36. 36. Transferring <ul><li>Standard backboard </li></ul><ul><ul><li>Patient may not fit </li></ul></ul><ul><ul><li>Board unable to support weight </li></ul></ul><ul><ul><li>Rescuers must grasp and maintain board, lift carry and maneuver in sync </li></ul></ul><ul><ul><li>Must lift from ground level to waist </li></ul></ul><ul><ul><li>Restricts breathing from prolonged period of lying flat </li></ul></ul>
  37. 37. Transferring <ul><li>Options to the standard backboard </li></ul><ul><ul><li>Specialized backboards </li></ul></ul><ul><ul><li>Basket stretchers </li></ul></ul><ul><ul><li>Reeves stretchers </li></ul></ul><ul><ul><li>Warehouse style carts </li></ul></ul>
  38. 38. Creating Company Policy <ul><li>Address the concerns </li></ul><ul><li>identifies strategies </li></ul><ul><li>sets limits on how few people may attempt to move a patient over a specified weight. </li></ul><ul><li>Ensure policy that personnel call for lift assistance when confronted with a patient who exceeds the lifting limits of the crew on scene. </li></ul>
  39. 39. Creating Company Policy <ul><li>Provide routine training that includes new strategies for morbidly obese patients in both emergency and non-emergency situations. </li></ul><ul><li>Ensure pre-planning among responders and the community </li></ul><ul><li>Remind all providers to remain non-judgmental </li></ul><ul><li>Problem-solving suggestions given by providers for consideration </li></ul>
  40. 40. Company Policy <ul><li>Obtain proper equipment that is reasonably priced </li></ul><ul><ul><li>Heavy rated stokes baskets or scoop stretchers lined with layers of blankets to be used as </li></ul></ul><ul><ul><ul><li>cushion </li></ul></ul></ul><ul><ul><ul><li>additional padding to elevate the patient’s head </li></ul></ul></ul><ul><ul><li>Expandable/connectable flats made from extra heavy-duty materials for the oversized patient </li></ul></ul><ul><ul><li>Equipment for securing the apparatus to the floor of the ambulance </li></ul></ul><ul><ul><li>Ramps used to slide the patient, with the least amount of lifting, during egress from a building and/or loading into and out of the ambulance </li></ul></ul>
  41. 41. Various Response Methods used by EMS agencies <ul><li>Patients that are too heavy for a 2-person medic unit can request fire department </li></ul><ul><li>MAN-S.A.C. rated at 1600 lbs. </li></ul><ul><li>Heavy duty collapsible litters rated at 600 lbs. </li></ul><ul><li>Dispatching trucks with additional personnel for lifting </li></ul><ul><li>Flagged address so initial responses include extra crews if available </li></ul><ul><li>Hold-harmless contracts if patient exceeds rated capacity of the stretcher </li></ul>
  42. 42. Proflexx with LBS
  43. 47. More Questions than Answers <ul><li>Is there a demand for a stretcher that could carry persons in excess of 500 lb? </li></ul><ul><li>Would a larger stretcher require a larger ambulance? </li></ul><ul><li>Would a larger stretcher require a different securing/locking device? </li></ul>
  44. 48. Many More Questions than Answers <ul><li>Would a larger ambulance stretcher allow enough room to provide patient care? </li></ul><ul><li>Are there federal or state regulations requiring mandatory transport of the morbidly obese patient? </li></ul><ul><li>What liability exposure the provider has when transporting a morbidly obese patient in an ambulance that cannot secure the transporting device to the vehicle? </li></ul>
  45. 49. Some Helpful Pointers <ul><li>Size-up building, check stairs and other escape routes </li></ul><ul><li>Think outside the box </li></ul><ul><li>Don’t exceed equipment ratings </li></ul><ul><li>Know cot capacity and weight limits </li></ul><ul><li>Appoint safety officer not working on the rescue to oversee health and safety issues </li></ul>
  46. 50. Best Practices <ul><li>Non-emergent transport </li></ul><ul><ul><li>Ascertain patient size </li></ul></ul><ul><ul><li>Schedule crew appropriately </li></ul></ul><ul><li>Size up the scene </li></ul><ul><li>Know patient’s weight </li></ul><ul><li>Match crew capability with task </li></ul><ul><li>Call for assistance before needed </li></ul>
  47. 51. More Helpful Tips <ul><li>Treat patient with dignity </li></ul><ul><li>Establish a system </li></ul><ul><ul><li>Write protocols </li></ul></ul><ul><ul><li>Practice runs </li></ul></ul><ul><ul><li>Assigned staff member to specialize in bariatric transfers </li></ul></ul><ul><li>Locate obese patients, preplan for future plans to each patients house </li></ul><ul><li>Evaluate patient mobility prior to transport </li></ul>
  48. 52. More Helpful Tips <ul><li>Scene assessment </li></ul><ul><ul><li>Door width </li></ul></ul><ul><ul><li>Steps </li></ul></ul><ul><li>Vehicle placement so terrain works in your favor </li></ul><ul><li>Personnel </li></ul><ul><li>Have a back-up plan </li></ul><ul><li>Cot designed to hold patients specific weight </li></ul>
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